Postoperative Right Ventriculo-Pulmonary Artery Coupling Assessed by TAPSE/PASP as a Predictor of Long-Term Outcomes After TAVI

BACKGROUND: Right ventriculo-pulmonary artery (RV-PA) coupling, commonly assessed by the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP), has emerged as an important prognostic marker in various cardiovascular diseases. However, its predictive value after transcatheter aortic valve implantation (TAVI) remains insufficiently defined. This study aimed to evaluate whether postoperative TAPSE/PASP is independently associated with long-term all-cause mortality in patients undergoing transfemoral TAVI. METHODS: We retrospectively analyzed 786 consecutive patients who underwent transfemoral TAVI between June 2020 and March 2025. Postoperative TAPSE/PASP was measured within the first week after the procedure. Receiver-operating characteristic (ROC) curve analysis determined the optimal TAPSE/PASP cut-off for predicting long-term mortality. Survival analyses were performed using the Kaplan-Meier method and Cox proportional hazards regression. RESULTS: During a median follow-up of 509 days (interquartile range: 283-847), 61 patients (9.0%) died. Receiver-operating characteristic (ROC) analysis identified 0.52 mm/mmHg as the optimal postoperative TAPSE/PASP cut-off (AUC = 0.626, P < .001, 95% CI: 0.57-0.68). Patients with TAPSE/PASP